Isolated isoperistaltic gastric tube interposition for esophageal replacement in children Emmanuel Gounot a , Jose ´phine Borgnon a , Frederic Huet b , Emmanuel Sapin a, * a Department of Pediatric Surgery, Hopital D’Enfants, University of Dijon, 21079 Dijon, France b Department of Pediatrics, Hopital D’Enfants, University of Dijon, 21079 Dijon, Cedex, France Abstract Various surgical procedures are used for esophageal substitution in children. With the gastric tube (GT) esophagoplasty procedures, main complications in the long term are related to gastric content reflux and acid production from the GT itself. A case of children operated on with a new procedure of isoperistaltic isolated GT interposition with favorable short- and long-term functional results is presented. D 2006 Elsevier Inc. All rights reserved. If the need for esophageal replacement in children has been dramatically reduced over the past 2 decades, esophageal substitution is required for resistant caustic esophageal stricture. Various alternatives for esophageal substitution have been proposed and their respective draw- backs widely discussed. We report the case of a boy treated with isoperistaltic gastric tube (GT) interposition with a favorable long-term result. 1. Case report A 5-year-old boy was hospitalized for a failed previous colonic graft performed 7 months ago for an intractable caustic esophageal injury. The formerly unsuccessful surgery has been a transhiatal colonic interposition with esophagectomy using the left transverse colon without thoracotomy, associated with a pyloroplasty. A stricture of the graft occurred and was progressively resistant to dilatation. The child complained of progressive total dysphagia, frequent spillover of saliva into the tracheo- bronchial tree, and repeated pneumonia. At last barium swallow, a full-length ischemic stricture of the colonic graft owing to inadequate blood supply could be observed. The decision to carry out a new esophageal replacement was taken on July 1995. The abdomen was entered through the previous midline incision. The previous colonic graft was closed distally with a stapler. The greater curvature of the stomach was measured to assure an adequate length to reach the neck. A GT was fashioned from the greater curvature of the stomach. The left gastroepiploic artery was divided near the splenic artery, and the short gastric vessels were ligated and divided. The gastrocolic omentum was divided, and its vessels were ligated as far as possible from the gastroepiploic arch. A transsection of the great curvature of the stomach was made 4 cm proximal to the pylorus, taking care to avoid any damage to the right gastroepiploic vessels. A silicone tube (20F) was inserted in the stomach through the opening and placed along the greater curvature from the antrum to the fundus. The GT was fashioned using a linear anastomosing stapler by 0022-3468/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.11.056 * Corresponding author. Service de Chirurgie Pediatrique, Ho ˆpital d’Enfants, 10 Bd du Mare ´chal de Lattre de Tassigny, 21079 Dijon, Cedex, France. Tel.: +33 03 80 29 50 82; fax: +33 03 80 29 51 40. E-mail address: emmanuel.sapin@chu-dijon.fr (E. Sapin). Index words: Gastric tube interposition; Esophageal replacement Journal of Pediatric Surgery (2006) 41, 592 – 595 www.elsevier.com/locate/jpedsurg